California Bill Would Have Judges Curb Psychotropics Among Foster Youth

After a year of scathing indictments by the media and advocates concerning the overuse of psychotropic drugs on foster children, the legislature responded with a flood of bills aimed at strengthening the safeguards for the prescription of psychological medications to foster youth. But some advocates worry that too much red tape will create barriers to treatment.

Among the bills on psychotropics introduced this session, Senate Bill 253 is the first attempt to legislate guidance to the juvenile courts on how to manage the prescribing process. Some children’s advocates say the bill has the potential to ensure that foster children get the same rights as other kids, though others caution that any increase in bureaucratic requirements may threaten the ability of foster youth to get the medical care they need in a timely manner.

The bill would instruct judges to make a legal determination regarding several factors based on “clear and convincing evidence” before approving prescriptions. This includes requiring medical examinations of the child prior to prescribing certain classes of drugs, making a second opinion necessary in ‘extreme prescribing cases,’ and requiring follow up monitoring on the effects of the medication, according to a statement from the bill’s author, State Senator Bill Monning (D-Carmel.)

California is one of only a few states to place the medical decisions for foster youth in the hands of the courts, according to Monning’s office. A decade ago, legislative attempts to guide the courts failed, in part because of the lack of funding. Now media attention has reinvigorated the debate.

“While previous efforts had been stalled due to the fiscal climate of the recession, we are now in a position of recovery where we can find funding for new, critical programs in underserved communities,” said Assemblymember David Chui (D-San Francisco,) the bill’s principal co-author, in an email forwarded by his representative. “There is a great deal of urgency on this issue.”

A previous dearth of funding underlies one of the key concerns of some organizations that believe such policies are often written in the absence of a complete picture of what the actual facts on the ground are.

Attempts by the state to fund research hit roadblocks a decade ago when similar measures to produce reliable data failed, according to Randall Hagar, Director of Government Relations for the California Psychiatric Association.

“Somewhere between a kid’s need for help and the state’s duty to make sure they get that help, there are huge bureaucracies,” Hagar said. “People have to be in it for the long term to try to solve these problems.”

“Physicians are finding it hard to continue providing services under the constraints of diminishing state compensation. Not only are additional costs incurred by mandates in the care special patient populations require, but legal proceedings may not be the best avenue for medical decision-making.”

The decision making process is already difficult because the data is so sparse on who is prescribing what medications and for what conditions. It is difficult to assess what a proper rate of medication would be among foster youth in group homes – the group most likely to have high prescription rates – according to Robert L. Hendren, D.O., Director of Child and Adolescent Psychiatry at the University of California, San Francisco medical school.

A 2012 study conducted by the Department of Health and Human Services has shown that children in out-of-home foster care are nearly two and a half times as likely to be prescribed psychotropic medications as similar children still living in a home where a report of maltreatment has occurred, a rate of 29.1 percent versus 11.7 percent.

“The problem is that some kids in the foster care system have a higher rate of mental disorders for a number of reasons including the stress of being in foster care,” said Hendren in an email. “Treatments (e.g. psychotherapy) other than or in addition to medication should be used as first line treatments but it will be a disservice to the children, their foster families and the psychiatrists trying to provide helpful intervention to create a time-consuming, onerous review system. Providing a time efficient, easy to use system will be more expensive so, hopefully, the system will be concerned enough to provide that necessary support.”

In its early stages, the goals of the bill have received widespread approval, though some express skepticism about how the details of the bill will play out even while agreeing on the need for action.

“There is a critical role for the appropriate prescribing and use of medicine,” said Priscilla Vanderveer, a media relations spokesperson specializing in state policy issues for the Pharmaceutical Research and Manufacturers of America. “There is also a need to strengthen efforts to ensure appropriate treatment of this particularly vulnerable population.”

Foster youth should have the same rights and supports as other children, and while the gravity of the problem has drawn widespread public attention, the instances of severe overmedication are not the norm, according to Simone Tureck, Executive Director of the Alameda County Foster Youth Alliance.

Tureck stressed the importance of emotional support and psychosocial treatments – therapy and creative activities – as important foundations for a treatment plan, but concedes that medication can be an important component of appropriate treatment.

“Some of these children are extremely difficult to get through the day without them feeling miserable and freaking out. But we need to make sure medication’s not the first line of defense and it’s not the only line of defense.”

The bill passed out of the Senate Human Services Committee on a 5 to 0 vote on April 21st.

Isaac Smith is an undergraduate at U.C. Berkeley. He wrote this story as part of the Journalism for Social Change class at U.C. Berkeley’s Goldman School of Public Policy.